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Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience
Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
The Cleveland Clinic, Cleveland OH, USA; New York University Medical Center, New York, USA.
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2012 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 256, no 5, p. 688-696Article in journal (Refereed) Published
Abstract [en]

Objective: To present the combined 14-year experience of 2 university centers performing endovascular aneurysm repair (EVAR) on 100% of noninfected ruptured abdominal aortic aneurysms (RAAA) over the last 32 months.

Background: : Endovascular aneurysm repair for RAAA feasibility is reported to be 20% to 50%, and EVAR for RAAA has been reported to have better outcomes than open repair.

Methods: We retrospectively analyzed prospectively gathered data on 473 consecutive RAAA patients (Zurich, 295; Örebro, 178) from January 1, 1998, to December 31, 2011, treated by an "EVAR-whenever-possible" approach until April 2009 (EVAR/OPEN period) and thereafter according to a "100% EVAR" approach (EVAR-ONLY period).Straightforward cases were treated by standard EVAR. More complex RAAA were managed during EVAR-ONLY with adjunctive procedures in 17 of 70 patients (24%): chimney, 3; open iliac debranching, 1; coiling, 8; onyx, 3; and chimney plus onyx, 2.

Results: Since May 2009, all RAAA but one have been treated by EVAR (Zurich, 31; Örebro, 39); 30-day mortality for EVAR-ONLY was 24% (17 of 70). Total cohort mortality (including medically treated patients) for EVAR/OPEN was 32.8% (131 of 400) compared with 27.4% (20 of 73) for EVAR-ONLY (P = 0.376). During EVAR/OPEN, 10% (39 of 400) of patients were treated medically compared with 4% (3 of 73) of patients during EVAR-ONLY. In EVAR/OPEN, open repair showed a statistically significant association with 30-day mortality (adjusted odds ratio [OR] = 3.3; 95% confidence interval [CI], 1.4-7.5; P = 0.004). For patients with no abdominal decompression, there was a higher mortality with open repair than EVAR (adjusted OR = 5.6; 95% CI, 1.9-16.7). In patients with abdominal decompression by laparotomy, there was no difference in mortality (adjusted OR = 1.1; 95% CI, 0.3-3.7).

Conclusions: The "EVAR-ONLY" approach has allowed EVAR treatment of nearly all incoming RAAA with low mortality and turndown rates. Although the observed association of a higher EVAR mortality with abdominal decompression needs further study, our results support superiority and more widespread adoption of EVAR for the treatment of RAAA.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2012. Vol. 256, no 5, p. 688-696
Keywords [en]
Abdominal compartment syndrome, abdominal decompression, chimney graft, debranching, endovascular repair, open abdomen treatment, open repair, ruptured abdominal aortic aneurysm
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-26548DOI: 10.1097/SLA.0b013e318271cebdISI: 000311223300006PubMedID: 23095611Scopus ID: 2-s2.0-84872026584OAI: oai:DiVA.org:oru-26548DiVA, id: diva2:573070
Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2018-05-10Bibliographically approved
In thesis
1. Aspects of endovascular treatment of abdominal aortic aneurysms
Open this publication in new window or tab >>Aspects of endovascular treatment of abdominal aortic aneurysms
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 77
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-25868 (URN)978-91-7668-904-2 (ISBN)
Public defence
2012-11-30, Wilandersalen, Universitetssjukhuset (USÖ), Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2017-10-17Bibliographically approved

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Norgren, LarsLarzon, Thomas

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